Defining the importance of daily glycemic control and implications for type 2 diabetes management.

Full Abstract

Glycemic control remains an elusive goal for most patients with type 2 diabetes. Questions concerning glucose targets that have emerged from recent outcomes studies further complicate glucose control strategies. Navigating through these challenges requires an understanding of the relationship between hyperglycemia, glycemic variability, and risk, as well as how to combine antidiabetic agents safely and effectively to minimize complications. Relevant data were selected from recently published major outcomes studies and peer-reviewed articles discussing glycemic variability, incretins, and dipeptidyl peptidase-4 inhibition. Incretin hormones play a premier role in maintaining normal glucose homeostasis. In type 2 diabetes, however, incretin functioning is impaired and glucose homeostasis is disturbed, contributing to hyperglycemia and both acute and chronic glucose fluctuations. Glycemic control efforts should involve quarterly glycated hemoglobin assessments, routine monitoring of daily blood glucose values, and combination therapy that targets both fasting and postprandial hyperglycemia. Dipeptidyl peptidase-4 inhibitors, which enhance endogenous incretin function, are well suited for combination with other agents to promote daily glycemic control without increasing the risk of hypoglycemia or weight gain. Results of recent outcomes studies suggest that a lifetime strategy for diabetes management might involve aggressive efforts to control glycemia daily and early in type 2 diabetes, with less stringent glucose targets and avoidance of hypoglycemia as patients acquire comorbidities, such as advanced cardiovascular disease. Dipeptidyl peptidase-4 inhibitors have the potential to play a vital role in diabetes management at all stages of the disease.

Author information

Author/s: Bode, Bruce W (BW);

Affiliation: Atlanta Diabetes Associates, Atlanta, GA 30309, USA. bbode001(-atsign-)aol.com

Journal and publication information

Publication Type: Journal Article; Research Support, Non-U.S. Gov't; Review

Journal: Postgraduate medicine (Postgrad Med), published in United States. (Language: eng)

Reference: 2009-Sep; vol 121 (issue 5) : pp 82-93

Dates: Created 2009/10/12; Completed 2009/11/04;

PMID: 19820277, status: MEDLINE (last retrieval date: 11/4/2009, IMS Date: )

Sourced from the National Library of Medicine. Abstract text and other information may be subject to copyright.

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MeSH headings (categories)

This article was linked to the MESH Headings shown below.

Adamantane - analogs & derivatives; therapeutic use
Antigens, CD26 - antagonists & inhibitors
Blood Glucose Self-Monitoring
Circadian Rhythm
Cost of Illness
Diabetes Complications - prevention & control
Diabetes Mellitus, Type 2 - drug therapy; metabolism
Dipeptides - therapeutic use
Disease Progression

Associated Chemicals: 3-hydroxyadamantylglycine-4,5-methanoprolinenitrile (0) ; Dipeptides (0) ; Hemoglobin A, Glycosylated (0) ; Incretins (0) ; Pyrazines (0) ; Triazoles (0) ; hemoglobin A1c protein, human (0) ; sitagliptin (0) ; Adamantane (281-23-2) ; Antigens, CD26 (EC 3.4.14.5) ; DPP4 protein, human (EC 3.4.14.5)

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